Calvaria Bone Graft

WHAT IS THE CALVARIA BONE GRAFT?

The maxillary bone can resorb for all kinds of reasons: age, following past dental extractions, or the consequence of a maxillary cyst, an abscess, osteitis, periodontal issues or other...

However, for dental implants to be placed, a sufficient bone thickness and height is necessary.

The skullcap or calvaria bone graft is a surgical procedure that aims to add bone in the upper or lower jaw by apposition, to allow future implant rehabilitation.

TESTS PRIOR TO THE SURGERY:

This procedure requires precise imaging: CTSCAN or a maxillary/mandibular and skull CONEBEAM, allowing the surgeon to quantify the lack of bone (transplanted site) and the amount of bone in the calvaria (donor site).

The surgical procedure takes place under general anesthesia. You'll be admitted as an inpatient since an overnight stay is necessary.

If you wish to have a private room, please inform the anesthesiologist and the surgeon as soon as possible and complete the administrative formalities specific to hospitals for private rooms (those rooms must be booked in advance).

Preoperative tests consist of a blood test, an electrocardiogram and sometimes a chest X-ray.

Once the tests are done, you can make an appointment with the anesthesiologist: The anesthesiologist needs the results of these tests for the preoperative consultation.

THE ACTUAL SURGERY:

Once the transplanted site cleared (Maxillary or Mandibular), an infiltration of local anesthesia is done in the skull, in the parietal area (behind the temple).

The hair is not usually shaved. An L-shaped incision approximately 5 cm long and 2 cm wide is made on the side of the skull. This clears the way for the bone area to be harvested.

The surgeon then uses an instrument called the Piezotome, which allows via vibrations to collect in an extremely accurate way a thin bone fragment of the outer cortex.

This bone fragment will be placed in the maxillary or mandible.

Filling material is sometimes used at the donor site before stitching.

The skin of the skull will be stitched and staples will be fixed to ensure a better healing.

A compressive dressing will be maintained for 24 hours.

In total, the surgery lasts 1h to 1h30, according to the case.

COST OF THE SURGERY:

This surgical procedure is not reimbursed by the INAMI.

The amount to be paid is set by the surgeon according to the amount of bone to be placed and the difficulty of the procedure (anatomical variations in the maxillae and sinuses).

The surgery costs 1500 euros.

You will receive an accurate estimate that you will need to sign before the surgery. A copy will be given to you and another one will be kept by the surgeon or the hospital.

POSTOPERATIVE RECOVERIES AND INSTRUCTIONS:

Generally, the calvaria bone harvesting is not painful.

In some cases, a hematoma may occur and cause swelling in the area of the donor site. All this is of course temporary. Using a compressive dressing immediately after the surgery, and the semi-sitting position reduce the hematomas.

Sometimes, if the surgeon deems it necessary, he can place a small drain to reduce the hematoma. Usually, you don't have to keep it for a long time.

You will be given all the medications you need in the recovery room.

Those drugs are mainly anti-inflammatories, painkillers and antibiotics.

Postoperative instructions:

Keeping the compressive dressing for the first night

• Do not smoke: Smoking promotes infections and reduces healing.
• Thoroughly brush your teeth and gums from the next evening with a very soft bristle toothbrush. Good oral hygiene is a guarantee of a successful operation.
• The nursing staff is available 24 hours a day during your hospital stay. They are perfectly aware of your case, so do not hesitate to call them when necessary! It's their job!
• When you leave the hospital, the nurse will give you an appointment with the surgeon for a postoperative examination, generally one week then 3 weeks after the surgical procedure, then according to the evolution. In case of any problem, do not hesitate to contact the surgeon via his assistant: they are available to handle the slightest problem.
• The bone takes at least 5 months to consolidate.
• A postoperative radiological evaluation is needed to quantify the new bone amount. After this, the surgeon will place the dental implants (at least 5 months after the transplantation).

OPERATIVE RISKS AND COMPLICATIONS:

Any surgical procedure, even performed in the best conditions of competence and safety in accordance with the current scientific data and the regulation in force, carries risks of complication, although they are very rare.

Hemorrhagic complication:

Very rare during the surgical procedure, it can exceptionally require a transfusion of blood or blood derivatives.

Infectious complication:

Very rare, it can cause swelling and redness that can be treated by antibiotic therapy only.

Non-union or insufficiency of the bone graft's height: parietal bone, although being the best bone for the onlay graft, can resorb. The surgeon takes this into account when grafting the bone. If the bone is insufficient, an additional bone replacement surgery may be exceptionally undertaken. In that case, the surgeon agrees not to charge you extra fee.
 
In all cases, your surgeon operates and provides immediate postoperative follow-up, but also short, medium and long-term follow-up. He is trained to operate but also to manage all the possible and rare complications of surgery.

Follow every one of his postoperative advices, and know that if you have a question or face any problem, your surgeon will help you and knows how to perfectly handle the situation.

Upon admission to the hospital, the following documents will be required:

• ID card,
• Supplemental insurance documents, if you have one,
• Signed informed consent (available here),
• Admission documents specific to the institution.